IVF Unit, Elisha Hospital, Haifa, Israel.
The Fertility Clinic, Skive Regional Hospital, Skive.
Curr Opin Obstet Gynecol. 2021 Jun 1;33(3):188-195. doi: 10.1097/GCO.0000000000000682.
In a conventional IVF cycle, final oocyte maturation and ovulation is triggered with a bolus of hCG, followed by progesterone-based luteal support that spans several weeks if pregnancy is achieved. This article summarizes several approaches of the exogenous progesterone-free luteal support in IVF.
Triggering ovulation with GnRH agonist may serve as an alternative to hCG, with well established advantages. In addition, the luteal phase can be individualized in order to achieve a more physiologic hormonal milieu, and a more patient friendly treatment, alleviating the burden of a lengthy exogenous progesterone therapy.
GnRH agonist trigger followed by a 'freeze all' policy is undoubtedly the best approach towards the 'OHSS-free clinic'. If fresh embryo transfer is considered well tolerated after GnRH agonist trigger, rescue of the corpora lutea by LH activity supplementation is mandatory. Herein we discuss the different approaches of corpus luteum rescue.
目的综述：在传统的体外受精（IVF）周期中，通过注射人绒毛膜促性腺激素（hCG）促使卵母细胞最终成熟并排卵，然后进行数周的孕激素为主的黄体支持，如果妊娠成功。本文总结了 IVF 中几种无孕激素的黄体支持方法。
最近发现：用 GnRH 激动剂触发排卵可能是 hCG 的替代方法，具有明确的优势。此外，可以对黄体期进行个体化，以实现更生理性的激素环境和更适合患者的治疗，减轻长时间外源性孕激素治疗的负担。
总结：GnRH 激动剂触发后进行“全部冷冻”策略无疑是实现“OHSS 无临床”的最佳方法。如果 GnRH 激动剂触发后认为新鲜胚胎移植耐受良好，则必须通过 LH 活性补充来挽救黄体。本文讨论了不同的黄体挽救方法。
